Uploaded August 2023 | Updated September 2026, 1 week ago
A rundown of 100 behaviors, management approaches, or systems issues that frustrate me as a hospitalist (i.e. a doctor who specializes in the care of the hospitalized patient), ranked according to how frustrating they are, how dangerous they are, how common they are, and how easy they would be to fix.
Pet peeves with evidence or consensus behind them:
#94: Which patients are really at risk for refeeding syndrome: pubmed.ncbi.nlm.nih.gov/32115791
#80: Definition and discussion of "prerenal AKI": ncbi.nlm.nih.gov/books/NBK560678
#78: Things We Do For No Reason: Echocardiography in hemodynamically stable patients with an acute PE; cdn.mdedge.com/files/s3fs-public/issues/articles/bergle0264_0419_v4.pdf
#75: Most patients presenting with cardiac tamponade are not hypotensive; pubmed.ncbi.nlm.nih.gov/17456823
#73: The presence of hypoxemia or an elevated A-a gradient is minimally diagnostically helpful in ruling out/in an acute PE; atsjournals.org/doi/full/10.1164/ajrccm.162.6.2004204
#72: Things We Do For No Reason: Things We do for No Reason: Routinely obtaining repeat transthoracic echocardiography for acute decompensation of known chronic heart failure; pubmed.ncbi.nlm.nih.gov/36739110
#64: The relative lack of evidence for using the INR and aPTT to predict peri-operative bleeding; from the American Society of Hematology: ashpublications.org/blood/article/130/Supplement%201/4654/72108/Bleeding-Risk-Using-INR-aPTT-Pre-Surgery-Systemtic (NOTE: While a minority of studies do find an elevated INR and/or aPTT are predictive of peri-operative bleeding, that is not the same thing as saying that bringing down those numbers with pre-operative FFP reduces bleeding risk - which is the real issue)
#63: Should urgent surgery be delayed due to a positive urine drug screen; tsaco.bmj.com/content/6/1/e000749 and bjanaesthesia.org.uk/article/S0007-0912(17)35367-9/fulltext
(NOTE: This is not the same thing as delaying *elective* surgery in patients with a positive urine tox screen for stimulants, which I think is more reasonable)
#53: Benzodiazepine use in the elderly is a bad idea; ncbi.nlm.nih.gov/pmc/articles/PMC7673272
#52: Description of the Levine technique for obtaining an accurate wound culture without the need for a surgical incision; msqc.org/wp-content/uploads/2019/02/WOUND-CULTURE-PROTOCOL.pdf
#51: Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults; pubmed.ncbi.nlm.nih.gov/30785419
A rundown of 100 behaviors, management approaches, or systems issues that frustrate me as a hospitalist (i.e. a doctor who specializes in the care of the hospitalized patient), ranked according to how frustrating they are, how dangerous they are, how common they are, and how easy they would be to fix.
Pet peeves with evidence or consensus behind them:
#94: Which patients are really at risk for refeeding syndrome: pubmed.ncbi.nlm.nih.gov/32115791
#80: Definition and discussion of "prerenal AKI": ncbi.nlm.nih.gov/books/NBK560678
#78: Things We Do For No Reason: Echocardiography in hemodynamically stable patients with an acute PE; cdn.mdedge.com/files/s3fs-public/issues/articles/bergle0264_0419_v4.pdf
#75: Most patients presenting with cardiac tamponade are not hypotensive; pubmed.ncbi.nlm.nih.gov/17456823
#73: The presence of hypoxemia or an elevated A-a gradient is minimally diagnostically helpful in ruling out/in an acute PE; atsjournals.org/doi/full/10.1164/ajrccm.162.6.2004204
#72: Things We Do For No Reason: Things We do for No Reason: Routinely obtaining repeat transthoracic echocardiography for acute decompensation of known chronic heart failure; pubmed.ncbi.nlm.nih.gov/36739110
#64: The relative lack of evidence for using the INR and aPTT to predict peri-operative bleeding; from the American Society of Hematology: ashpublications.org/blood/article/130/Supplement%201/4654/72108/Bleeding-Risk-Using-INR-aPTT-Pre-Surgery-Systemtic (NOTE: While a minority of studies do find an elevated INR and/or aPTT are predictive of peri-operative bleeding, that is not the same thing as saying that bringing down those numbers with pre-operative FFP reduces bleeding risk - which is the real issue)
#63: Should urgent surgery be delayed due to a positive urine drug screen; tsaco.bmj.com/content/6/1/e000749 and bjanaesthesia.org.uk/article/S0007-0912(17)35367-9/fulltext
(NOTE: This is not the same thing as delaying *elective* surgery in patients with a positive urine tox screen for stimulants, which I think is more reasonable)
#53: Benzodiazepine use in the elderly is a bad idea; ncbi.nlm.nih.gov/pmc/articles/PMC7673272
#52: Description of the Levine technique for obtaining an accurate wound culture without the need for a surgical incision; msqc.org/wp-content/uploads/2019/02/WOUND-CULTURE-PROTOCOL.pdf
#51: Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults; pubmed.ncbi.nlm.nih.gov/30785419
